AmeriHealth Caritas District of Columbia (DC)
Dental Provider Satisfaction Survey

Question Title

* 1. Please mark who is completing this survey.

Dental Provider

Dental Hygienist

Dental Practice Manager/Staff

Business Owner of Dental Practice

Other (please specify)

Question Title

* 2. Please rate…

	Excellent	Good	Fair	Poor	N/A
Your overall satisfaction with AmeriHealth Caritas DC.	Your overall satisfaction with AmeriHealth Caritas DC. Excellent	Your overall satisfaction with AmeriHealth Caritas DC. Good	Your overall satisfaction with AmeriHealth Caritas DC. Fair	Your overall satisfaction with AmeriHealth Caritas DC. Poor	Your overall satisfaction with AmeriHealth Caritas DC. N/A
AmeriHealth Caritas DC’s timeliness to answer questions and/or resolve problems.	AmeriHealth Caritas DC’s timeliness to answer questions and/or resolve problems. Excellent	AmeriHealth Caritas DC’s timeliness to answer questions and/or resolve problems. Good	AmeriHealth Caritas DC’s timeliness to answer questions and/or resolve problems. Fair	AmeriHealth Caritas DC’s timeliness to answer questions and/or resolve problems. Poor	AmeriHealth Caritas DC’s timeliness to answer questions and/or resolve problems. N/A
The relevance and helpfulness of AmeriHealth Caritas DC’s written communications, provider alerts, manuals, etc.	The relevance and helpfulness of AmeriHealth Caritas DC’s written communications, provider alerts, manuals, etc. Excellent	The relevance and helpfulness of AmeriHealth Caritas DC’s written communications, provider alerts, manuals, etc. Good	The relevance and helpfulness of AmeriHealth Caritas DC’s written communications, provider alerts, manuals, etc. Fair	The relevance and helpfulness of AmeriHealth Caritas DC’s written communications, provider alerts, manuals, etc. Poor	The relevance and helpfulness of AmeriHealth Caritas DC’s written communications, provider alerts, manuals, etc. N/A
The timeliness and accuracy of AmeriHealth Caritas DC’s claims processing.	The timeliness and accuracy of AmeriHealth Caritas DC’s claims processing. Excellent	The timeliness and accuracy of AmeriHealth Caritas DC’s claims processing. Good	The timeliness and accuracy of AmeriHealth Caritas DC’s claims processing. Fair	The timeliness and accuracy of AmeriHealth Caritas DC’s claims processing. Poor	The timeliness and accuracy of AmeriHealth Caritas DC’s claims processing. N/A
The availability of health education materials and training opportunities.	The availability of health education materials and training opportunities. Excellent	The availability of health education materials and training opportunities. Good	The availability of health education materials and training opportunities. Fair	The availability of health education materials and training opportunities. Poor	The availability of health education materials and training opportunities. N/A

Question Title

* 3. How likely are you to recommend AmeriHealth Caritas DC to other dental practices?

Very Likely

Somewhat Likely

Unlikely

Never

N/A

Very Likely

Somewhat Likely

Unlikely

Never

N/A

Question Title

* 4. Is there anything else you would like AmeriHealth Caritas DC to know?

Question Title

* 5. If you would like to enter for a $100 gift card upon completing this survey, please provide the following information so we can contact you with details about receiving the gift card. The gift card will be offered to the dental practice of one randomly selected survey respondent.

Name of Business Owner for Dental Practice (First and Last)

Email of Business Owner for Dental Practice

Mailing Address of Dental Practice

AmeriHealth Caritas District of Columbia (DC) Dental Provider Satisfaction Survey

Question Title

* 1. Please mark who is completing this survey.

Question Title

* 2. Please rate…

Question Title

* 3. How likely are you to recommend AmeriHealth Caritas DC to other dental practices?

Question Title

* 4. Is there anything else you would like AmeriHealth Caritas DC to know?

Question Title

* 5. If you would like to enter for a $100 gift card upon completing this survey, please provide the following information so we can contact you with details about receiving the gift card. The gift card will be offered to the dental practice of one randomly selected survey respondent.

AmeriHealth Caritas District of Columbia (DC)
Dental Provider Satisfaction Survey